Effect of smoking on utilization of and expenses in ambulatory dental care

Sun-Rak Jeong; Young-Hee Kim; Ji-Eon Jang; Won Kee Lee

doi:10.11149/jkaoh.2015.39.4.288

Journal List > J Korean Acad Oral Health > v.39(4) > 1057663

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jeong, Kim, Jang, and Lee: Effect of smoking on utilization of and expenses in ambulatory dental care

Original Article

J Korean Acad Oral Health 2015;39(4):288-294.

Published online: 12 December 2015

DOI: https://doi.org/10.11149/jkaoh.2015.39.4.288

Effect of smoking on utilization of and expenses in ambulatory dental care

Sun-Rak Jeong¹, Young-Hee Kim¹, Ji-Eon Jang², Won Kee Lee³

¹Department of Public Health, Graduate School, Kyungpook National University, Daegu, Korea

²Department of Dental Hygiene, Suseong College, Daegu, Korea

³School of Medicine, Kyungpook National University, Daegu, Korea

Corresponding Author: Won Kee Lee School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro Jung-gu, Daegu 41944, Korea Tel: +82-53-420-6939 Fax: +82-53-425-9937 E-mail: wonlee@knu.ac.kr

Received 1 October 2015 Revised 23 October 2015 Accepted 5 November 2015

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The objectives of this study were to evaluate the effect of smoking on utilization of and expenses in ambulatory dental care.

Methods

The subjects of this study were 5,751 men aged over 20 years selected from the Korea Health Panel data collected during 2010-2012. Pack-years of smoking were calculated based on the survey data. Dental utilization was defined as dental outpatient clinic use least once in three years. The expenses in ambulatory dental care were summed to determine total dental health care spending for three years. To detect the effect of smoking, we used multiple logistic regression analysis for dental utilization and multiple linear regression for expenses in ambulatory dental care after changing log.

Results

The pack-years had a significant effect on dental utilization and expenses in participants aged 40-59 years. After controlling for income level, bedtime brushing, and the presence of chronic disease, dental care utilization rates in the over 10 to less than 25 pack-year and the over 25 pack-year groups were about 1.4 (OR=1.37, (P=0.007)) and 1.6 times (OR=1.59, (P=0.001)) those in the 0 pack-year group. In comparison with the 0 pack-year group, the over 10 to less than 25 pack-year group spent 50,000 won more over dental expenses, while the corresponding number for the over 25 pack-year group was about 100,000 won. Thus, the ambulatory dental care expenses increased with the pack-years of smoking.

Conclusions

Smoking significantly influenced the utilization and expense in ambulatory dental care in men aged 40-59 years.

Keywords: Expense in ambulatory dental care, Pack-years of smoking, Utilization of ambulatory dental care

References

1. Statistics Korea, News, Press Releases, Social statistics, The Summary Result of the 2014 Social Survey [Internet]. [cited 2015 Nov 05]. Available from:. http://kostat.go.kr/portal/english/news/1/19/5/index.board.

2. Jee SH, Lee JK, Kim IS. Smoking-attributable mortality among Korean adults: 1981-2003. Korean J Epidemiol. 2006; 28:92–99.

3. Yoon SJ, Ha BM, Kang JW, Chang HC. Estimation of attributable burden due to premature death from Smoking in Korea. Korean J Prev Med. 2001; 34:191–199.

4. Johnson GK, Slach NA. Impact of tobacco use on periodontal status. J Dent Educ. 2001; 65:313–321.

5. Scabbia A, Cho KS, Sigurdsson TJ, Kim CK, Trombelli L. Cigarette smoking negatively affects healing response following flap debridement surgery. J Periodontol. 2001; 72:43–49.

6. Sham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tabacco use on oral health. Hong Kong Med J. 2003; 9:271–277.

7. Heasman L, Stacey F, Preshaw PM, McCracken GI, Hepburn S, Heasman PA. The effect of smoking on periodontal treatment response: A review of clinical evidence. J Clin Periodontol. 2006; 33:241–253.

8. Baelum Vibeke. CPITN and the epidemiology of periodontal disease. Community Dent Oral Epidemiol. 1996; 24:367–8.

9. Millar WJ, Locker D. Smoking and oral health status. JCDA. 2007; 73:155–155.

10. Peto R. Smoking and death: the past 40 years and the next 40. BMJ. 1994; 309:937–939.

11. Jung YH, Ko SJ, Lee YG, Park SB, Lee JH. Lifetime cost of obesity and smoking and long-term effectiveness of health promotion. KI-HASA. 2010.

12. National Health Insurance Service, Understanding for Korea Health Panel. KIHASA. 2008.

13. Kim HS, Kim MK, Shin HS. Expenditure in ambulatory dental care and factors related to its spending. HPM. 2012; 22:207–224.

14. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. 2013 6th(1st year) national health statistics.

15. Han DH, Kim JB. The association between smoking and periodontitis: finding from The Korean National Oral Health Survey 2006. J Korean Acad Dent Health. 2009; 33:634–643.

16. Ryu MH. The effects of smoking on oral mucosa. The Journal of Namseoul Univ. 2004; 10:449–468.

17. Reibel J. Tobacco and oral diseases. Med Princ Pract. 2003; 12:22–32.

18. Preber H, Linder L, Bergstrom J. Periodontal healing and perio-pathogenic microflora in smokers and non-smokers. J Periodontol. 1995; 22:946–952.

19. Pindborg JJ. Dental aspects of osteogenesis imperfecta. APMIS. 1947; 24:47–58.

20. Arno A, Waerhaug J, Lovdal A, Schei O. Incidence of gingivitis as related to sex, occupation, tabacco consumption, toothbrushing, and age. Oral Surg Oral Med Oral Pathol. 1958; 11:587–595.

21. Grossi SG, Genco RJ, Machtei EE, Ho AW, Koch G, Dunford R, et al. Assessment of risk for periodontal disease. Ⅱ. Risk indicators for alveolar bone loss. J Periodontol. 1995; 66:23–29.

22. Martinez-Canut P, Lorca A, Margan R. Smoking and periodontal disease severity. J Clin Periodontol. 1995; 22:743–749.

23. Harber J, Kent RL. Cigarette smoking in periodontal practice. J Peri-odontol. 1992; 63:100–106.

24. Holm G. Smoking as an additional risk for tooth loss. J Periodontol. 1994; 65:996–1001.

25. Park HD. The impact of smoking on the utilization of dental health services [master’s thesis]. Seoul: Graduate School of Public Health Yonsei Univ;2008. Korean.

26. Park JH, Kim YN, Yoo JH, KIM MY, Kim BI, Kwon HK. Relationship between smoking and periodontal pocket formation in Korean adults. J Korean Acad Dent Health. 2005; 29:293–301.

27. Song AR, Park JW. A study on the attitudes about smoking and factor analysis among women students of college -By oriented students of Gimcheon College. Gimcheon College Report. 2004; 25:113–138.

Fig. 1.

Crude utilization ambulatory dental care rate according to smoking pack-years in the 40-59 age group.

Table 1.

General Characteristics according to experience and pack-years of smoking

		Smoking experience		P₁	Pack-years of smoking Median (Q1-Q3)	P₂
		No	Yes
		n (%)	n (%)
Age	<40	671 (56.9)	508 (43.1)	<.001	0 (0-4)	<.001
	40-59	523 (21.9)	1,860 (78.1)		12 (2-21)
	60≤	408 (18.6)	1,781 (81.4)		22 (7-40)
Marital status	Marriage	897 (20.6)	3,452 (79.4)	<.001	15 (3-29)	<.001
	Divorce etc.	40 (15.3)	221 (84.7)		19 (6-30)
	Single	665 (58.3)	476 (41.7)		0 (0-5)
Education level	≤Middle school	282 (19.2)	1,189 (80.8)	<.001	23 (7-40)	<.001
	High school	549 (26.7)	1,511 (73.3)		12 (0-24.5)
	University≤	771 (34.7)	1,449 (65.3)		5 (0-15)
Type of health insurance	Workplace health insurance	1,067 (29.0)	2,610 (71.0)	0.030	10 (0-23)	<.001
	Regional health insurance	460 (25.6)	1,334 (74.4)		13 (0-27)
	Medical care assistance	75 (26.8)	205 (73.2)		15 (0-30)
Family income	Site 1	171 (21.2)	636 (78.8)	<.001	20 (3-37)	<.001
(based on 2010)	Site 2	267 (25.2)	791 (74.8)		14 (0-30)
	Site 3	308 (25.4)	906 (74.6)		11 (0-24)
	Site 4	412 (30.9)	921 (69.1)		8 (0-20)
	Site 5	444 (33.2)	895 (66.8)		7 (0-20)
Brushing teeth (after breakfast) (based on 2010)	No	565 (29.6)	1,346 (70.4)	0.041	10 (0-23)	<.001
	Yes	1,037 (27.0)	2,803 (73.0)		11 (0-2)
Brushing teeth (after lunch)	No	1,005 (27.3)	2,676 (72.7)	0.212	13 (0-28)	0.001
	Yes	597 (28.8)	1,473 (71.2)		8 (0-20)
Brushing teeth (before bedtime)	No	650 (25.3)	1,921 (74.7)	0.869	14 (0-29)	<.001
	Yes	772 (25.5)	2,259 (74.5)		10 (0-24)
Chronic Disease	No	1,334 (31.3)	2,929 (68.7)	<.001	8 (0-20)	<.001
	Yes	268 (18.0)	1,220 (82.0)		20 (6-35)
Total		1,602 (27.9)	4,149 (72.1)

P : Chi-square test, P : Wilcoxon's rank sum test or Kruskal-Wallis test.

Table 2.

Effects of pack-years of smoking on dental utilization by age

Age	Pack- years of Smoking	n	Crude			Adjusted
Age	Pack- years of Smoking	n	OR	(95% C.I.)	P	OR	(95% C.I.)	P
<40	0.0	671	1.00			1.00
	0.1-9.9	407	0.83	(0.64-1.08)	0.166	0.90	(0.67-1.20)	0.463
	10.0-24.9	101	0.64	(0.40-1.02)	0.059	0.71	(0.43-1.15)	0.162
25.0≤
40-59	0.0	523	1.00			1.00
	0.1-9.9	471	1.21	(0.93-1.57)	0.156	1.22	(0.94-1.58)	0.144
	10.0-24.9	933	1.32	(1.06-1.66)	0.014	1.37	(1.09-1.71)	0.007
	25.0≤	456	1.53	(1.18-1.98)	0.001	1.59	(1.22-2.07)	0.001
60≤	0.0	408	1.00			1.00
	0.1-9.9	201	0.95	(0.68-1.33)	0.769	0.97	(0.70-1.36)	0.859
	10.0-24.9	547	0.84	(0.65-1.09)	0.189	0.85	(0.65-1.10)	0.207
	25.0≤	1,003	0.93	(0.74-1.17)	0.522	0.97	(0.77-1.22)	0.771

Adjusted OR: adjusted for income level (stage 1-5), whether brushing teeth, and the presence or absence of chronic diseases.

Table 3.

Cure rate by treatment contents according to pack-years in 40-59 years (Unit : %)

	Pack-years group				^P₁	^P₂
	0	0.1-9.9	10.0-24.9	25.0≤
	(n=523)	(n=471)	(n=933)	(n=456)
Dental caries	17.9	19.3	21.7	23.9	.100	.013
Dentures	0.6	0.2	0.9	0.9	.505	.317
Dental prothesis	1.9	3.6	3.0	5.7	.009	.006
Tooth to implant	3.8	4.7	4.3	4.8	.869	.541
Orthodontia	0.2	0.4	0.0	0.7	.112	.509
Gum treatment (Teeth scaling etc.)	20.7	24.2	23.4	25.9	.269	.088
Endodontic treatment	10.5	11.4	12.2	14.0	.386	.091
Extraction of teeth	6.3	9.1	10.1	16.5	<.001	<.001
Tooth sealant	1.2	1.5	1.5	1.1	.895	.966
Whitening	0.0	0.2	0.0	0.4	.129	.192
Etc.	11.5	11.5	11.4	12.7	.894	.631
Teeth pulling transfer, Teeth filling	5.2	5.3	5.3	4.4	.903	.604

P : Chi-square test, P : Mantel-Haensel linear trend test.

Table 4.

Effects of pack-years of smoking on expense of ambulatory dental care by age unit: won (￦)

Age	Pack-years of smoking	n	Mean of expense (￦)	SD of expense (￦)	P	post-hoc comparision
<40	0.0	671	260,020	994,958	0.154
	0.1-9.9	407	194,206	767,414
	10.0≤	101	386,119	1,547,923
40-59	0.0	523	206,613	797,005	0.038	Reference
	0.1-9.9	471	242,630	880,523		0.231
	10.0≤	933	250,086	989,309		0.048
	25.0≤	456	302,071	1,034,669		0.002
60≤	0.0	408	365,699	1,033,658	0.049	Reference
	0.1-9.9	201	384,036	960,048		0.982
	10.0-24.9	547	372,722	1,179,926		0.088
	25.0≤	1,003	395,368	1,249,447		0.046

Post-hoc comparision: If the Kruskal-Wallis test showed a significant difference between the groups, then comparisons between reference and other one group for post-hoc test were done by employing the Mann-Whitney U-test using Bonferroni correction to adjust the probability.

Table 5.

Effects of smoking history on expense of ambulatory dental caer in the group of 40-59 years old

		Estimated regressior coeficient	S.E.	t	P1	P2
Constant		2.59	0.52	4.97	<.001
PaCk-Vears of smoking	0.0	Reference				0.001
	0.1-9.9	0.42	0.37	1.14	0.255
	10.0-24.9	0.80	0.32	2.52	0.012
	7§0<	116	037	2,10	0,007
Family income (based on 2010)	Site 1	Reference
	Site 2	1.15	0.53	2.15	0.032
	Site 5	1.85	0.51	3.60	0.000
	Site 4	1.60	0.50	3.20	0.001
	Site 5	1.84	0.50	3.65	0.000
Brushing teeth (before bedtime) (based on 2010)	No	Reference
	Yes	70.40	0.25	71.61	0.109
Chronic disease	No	Reference
	Yes	7044	ma	71%?	0186

The expense of ambulatory dental care was used ‘0’ won in case of ‘0’ won and natural log value in case of more than ‘1’ won, P1: Significance pro] ability of estimated regression coefﬁcient, P2: Signiﬁcance probability of linear trend according to paCk-years of smoking. Adi—R2=O.OH.

TOOLS

Similar articles